West Virginia Office of Miners' Health Safety and Training
Permit
Applications and Reporting Forms
for
Independent Contractors
The
following links are intended to provide the West Virginia Mining industry
and the miners of the state with downloadable versions of the common
applications and documents required by WVMHS&T. Additional documents will be added as
necessary. General descriptions and instructions are listed with the form
links.
Our forms require Acrobat Reader
to view and
download. To download a free version of the current Acrobat Reader, follow the
link above.
PRIVACY NOTICE. This privacy notice discloses the privacy practices for the West Virginia Office of Miners’ Health Safety and Training. This privacy notice applies solely to information collected by this agency.
Permitting Application Forms - Independent Contractors
The
following application forms for Independent Contractors are available either
as individual forms or as a permit package containing all of the Independent Contractor permit
applications. Additional information may be found on our
Independent Contractor page.
(Revised 3-09)
Contractor Permit Instructions
Contractor Permit Instructions. (Revised 6-10)
instructional memo available for contractors. It details the
steps necessary to obtain a contractors permit from WV MHS&T.
Permit Package (all Contractor permit applications)
Independent Contractor Comprehensive Mine Safety Program (Initial
Submittal) Package
(Revised 6-10) contains the forms necessary for a new Contractor
Safety Program. Must be submitted to the WV MHS&T Regional office
for approval. The following link is a sample of a generic WV
Comprehensive Mine
Safety Program that may be filed with the initial submittal form for the CMSP.
This form should suffice for most non-production contractors or trucking
companies. You may be required to modify this program based on the specific
needs of your business. Generic Safety Program
(revised 8-2009)
For Independent Contractors providing contracted labor services
on mine sites, the following Generic Safety Programs are provided:
Generic Comprehensive Mine Safety
Program for Companies Providing Contract Labor at Underground Mines
Generic Comprehensive Mine Safety
Program for Companies Providing Contract Labor at Surface Mines
(If you are not sure which Safety Program best applies to your business
please contact the Regional Office and speak with a Safety Instructor.)
DMM-60C Application
DMM-60c is the application for an
Independent Contactor permit.
Independent Contractor General
Information (fill-able PDF format)
Independent Contractor General Information
(non fill-able PDF format)
(Revised 3-09)
General Information
forms
must be filed for all new or re-newed Certificates of Approval issued by this
agency. Both sides of the form are required to be completed or the permit will not
be processed.
Contract Labor Memo and
Questionaire
WV Division of
Labor Forms
Division of Labor Forms, including: MHS&T Tracking Sheet, Exemption Request,
DOL License Forms and Wage Bonding Affidavit
(Revised 3-09)
are West Virginia
Division of Labor forms for your permit
package. They are provided here for your convenience.
Comprehensive Safety Program (Initial Submittal) Package
Independent Contractor Comprehensive Mine Safety Program (Initial
Submittal) Package contains the forms necessary for a new Contractor
Safety Program. Must be submitted to the WV MHS&T Regional office
for approval. The following link is a sample of a generic WV
Comprehensive Mine
Safety Program that may be filed with the initial submittal form for the CMSP.
This form should suffice for most non-production contractors or trucking
companies. You may be required to modify this program based on the specific
needs of your business. Generic Safety Program
Annual Contractor Permit Extension Application Package (fill-able PDF format) Annual Contractor Permit Extension Application Package (non fill-able PDF format) Independent Contractor Annual Permit Extension Application Package contains the forms necessary to apply for an annual extension of the independent contractor permit.
Request for Exemption from the requirements for the independent contractor certificate of approval. (updated)
Reporting Forms
Injury/Accident Report The Injury/Accident form is a two sided form and is to be used for reporting all types of mining accidents. Three copies will need to be filed--follow the instructions on the first page.
Contractor Reporting Form
Independent Contractor
Monthly Reporting form. Title 56 Series 10
Note: Monthly Reports may be filed electronically. For more information or to apply for this service use the following link:
Apply for on-line reporting access.
[MHS&T
Homepage] [
Publications Page] [ Frequently
Asked Questions]
[Forms Main Page]
[Miner Certification
Forms] [Mining Forms]
Note: The information obtained from these documents is accurate to the best of our knowledge and is not a substitute for current mining laws or regulations. The state is not liable for any damages resulting from any information that unintentionally may be inaccurate or untimely.
If you don't find the form you need, or if you have accessibility issues with our forms, please contact us by email (see the link below) and we will assist you. We have attempted to make our forms accessible as required by state and federal regulations.
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Office of Miners' Health Safety and Training.
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Date this page was last updated:
06/18/2010